Localising intracerebral haemorrhage by site

What it is

Stroke divides into ischemic and hemorrhagic. Ischemic stroke is broken down into large vessel (20%), small vessel (25%), cardioembolic (20%), other (5%) and cryptogenic (35%). Hemorrhagic stroke is broken down into intracerebral hemorrhage and subarachnoid hemorrhage. Ischemic stroke is more common than hemorrhagic: 80% ischemic, 20% hemorrhagic.

Causes and risk

The causes given for intracerebral hemorrhage are HTN, tumor, stroke, vascular malformation, TCP, coagulopathy, amyloid and trauma. The causes given for subarachnoid hemorrhage are trauma and aneurysm.

How it presents

The site of the bleed is read off the neurologic findings, and the eyes are what parts the two that look alike. Basal ganglia hemorrhage gives contralateral hemiparesis and hemisensory loss with homonymous hemianopsia and gaze palsy. Thalamic hemorrhage gives the same contralateral hemiparesis and hemisensory loss but adds nonreactive miotic pupils, an upgaze palsy, and eyes that deviate toward the hemiparesis. A cerebral lobe bleed gives contralateral hemiparesis from the frontal lobe, contralateral hemisensory loss from the parietal lobe and homonymous hemianopsia from the occipital lobe, with a high incidence of seizures and eyes that deviate away from the hemiparesis; so which way the eyes deviate parts the thalamus from the lobe. Cerebellar hemorrhage usually gives no hemiparesis at all, but facial weakness, ataxia and nystagmus with occipital headache and neck stiffness, and a bleed in the pons gives deep coma and total paralysis within minutes with pinpoint reactive pupils.